Provider Demographics
NPI:1235163866
Name:KATTA, PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:KATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 MOWRY AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1605
Mailing Address - Country:US
Mailing Address - Phone:510-248-1000
Mailing Address - Fax:510-608-6055
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1603
Practice Address - Country:US
Practice Address - Phone:510-248-1550
Practice Address - Fax:510-793-8783
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79208207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI11047Medicare UPIN